Barriers and Facilitators to Emergency Care: Acute Injury in the Kilimanjaro Region

Background: Trauma and injury present a significant global burden – one that is only exacerbated in low- and middle-income settings like Tanzania. We aimed to describe the landscape of emergency care and financial catastrophe in the Kilimanjaro region by leveraging the Three Delays Model.

Methods: This was a cross-sectional study using an ongoing traumatic injury registry as well as separate financial questionnaires collected by researchers from the Duke Global Health Institute at Duke University in collaboration with the Kilimanjaro Christian Medical Centre (KCMC) in Moshi, Tanzania from December 2022 until February 2023.

Results: The majority of the acute injury population that presented to the KCMC emergency department underwent some form of financial catastrophe due to the out-of-pocket (OOP) costs incurred due to their medical needs (catastrophic health expenditure (CHE): 66.1%; impoverishment: 85.5%). The households of those who experienced a financial catastrophe tended to include a greater number of dependents (CHE, 22% and impoverishment, 21% with ≥6 dependents) and a lower average monthly adult-equivalent income (CHE: 76,923 TZS; impoverishment: 96,774 TZS). Individuals who underwent a financial catastrophe also experienced a greater number of facility transfers as well as more transfers with later surgery. At the end of an individual’s hospital stay, those who experienced financial catastrophe incurred substantially more medical expenses. Those who experienced a CHE had OOP costs that were 3.4 times higher than those without; those who were impoverished had OOP costs that were 1.96 times higher than those who did not.

Conclusions: Delay 1 (decision to seek care) and Delay 2 (reaching appropriate care facility) could be significant factors for those who will later experience some form of financial catastrophe. Further research is needed to better assess potential impacts on patient health outcomes and develop targeted intervention strategies for those most at-risk.